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EOSS Assesses More Than Just Cardiometablic Risk

Readers of these pages will be quite familiar with the Edmonton Obesity Staging System (EOSS) that is increasingly used in clinical practice to stratify patients presenting with overweight or obesity in terms of actual health status (rather than just BMI).

Previous studies have shown that EOSS is a far better predictor of cardiovascular and overall mortality than BMI or waist circumference. However, its performance compared to other measures of cardiometabolic risk is not known.

Now, a study by Keisuke Ejima and colleagues, published in Obesity, compares the predictive value for mortality and years of life lost between EOSS and Cardiometabolic Disease Staging (CMDS) in NHANES.

Whereas CMDS is scored based on the the presence of cardiometabolic risk factors, EOSS is scored on a much broader range of parameters including mental, medical, and functional health.

In their analyses, both CMDS and EOSS consistently identified individuals at higher mortality risk. Thus, the median years of life lost for EOSS scores 2 and 3 (low to high risk) for a reference person were 1.19 and 6.76 years. Those for CMDS scores 1, 2, 3, and 4 (low to high risk) were 1.53, 2.90, 3.91, and 8.51 years. 

In their interpretation of these findings, the authors discuss that CMDS may have greater clinical utility not only because it appears to have better discriminatory power but also uses fewer items to risk stratify.

To me the findings are not surprising and if all you are interested in is mortality, then clearly all you need to calculate is CMDS – which was specifically designed and validated to assess cardiometbolic risk.

However, in clinical practice, mortality is only one of the parameters of interest. Many may argue that other parameters including mental health, chronic pain, or even just quality of life may be as, if not more important to patients, than whether or not they live a couple of years longer or not. Thus, clinical decisions around treatments need to take more into account than just cardiometabolic risk.

It is for this very reason that EOSS was conceptualised as a much broader assessment of health than just cardiometabolic risk.

Thus, it may well be that both staging systems may find their place in clinical practice – CMDS for clinicians and patients who prefer a narrower focus on mortality risk and life expectancy, EOSS for clinicians and patients who prefer to consider a broader definition of health that includes other medical issues (e.g. chronic pain, fertility issues, etc.), as well as mental and functional health.

Edmonton, AB

1 Comment

  1. Commenting as not a doctor or RD but fairly average 45 year old women that has fought against obesity since her early 20s.

    We are confused. There are no easy answers or gold standard methods to follow from our medical community. I’ve done every diet under the sun, including Bernstein, Atkins, Weight Watchers, Intermittent Fasting.

    My small-boned 5 7’ inch body has slowly grown (large jumps after reaching my goals from each diet) from 140 to 220. I always incorporate exercise although my arthritis seems to get worse, and the ability to actually lose weight gets increasingly difficult. I’ve increased my exercise to the point where I ended up with rhabdo. Regardless, when I commit, I always reached my goal weight. Then gain it all back, plus.

    My most recent attempt started 2 months ago. I realized I’ve always lost weight with a goal in mind – usually using extreme methods. No goal this time, I figured I’d eat in a way I could manage forever and it would come off, albeit slowly. After sticking to one meal a day for the past year and still gaining, I’ve been doing 45 mins of a mix of cardio and HIIT training everyday, and walk/jogging 3xs a week for 3kms. I decided to weigh myself after 2 months of this, 2 lbs lost.

    I’m at a loss. Reading about The Biggest Loser and how most contestants gained their weight back, and a year later their RMR has dropped even further, I’m feeling hopeless. I’ve tried researching and all I see is how losing weight just creates an ugly cycle of gain/loss and bumping up exercise until it’s basically your life, just to maintain.

    I recently decided I’d see what medical assistance there is…there isn’t. Unless your BMI is > 45. Which is kind of shocking because I thought part of the solution might be to help people before their BMI is so high. My doctor suggested lirgatude but if will lower my metabolism even further and it’s not even covered, it’s not worth it.

    Am I missing something? Is there an answer to keep he weight off? Does Alberta have programs/assistance for those of us obese individuals that are watching our bodies just get heavier and heavier and are terrified now and for our futures?

    Thank you for the opportunity to post a comment.

    Post a Reply

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